Olubajo Babatunde, Mitchell-Fearon Kathryn, Ogunmoroti Oluseye
Eastern Health Research and Analysis, Inc., 1 Press Place, Athens, GA 30601, USA.
Department of Community Health and Psychiatry, The University of the West Indies, Mona, Kingston 7, Jamaica.
Interdiscip Perspect Infect Dis. 2014;2014:625670. doi: 10.1155/2014/625670. Epub 2014 Mar 20.
HIV infection is no longer characterized by high morbidity, rapid progression to AIDS, and death as when the infection was first identified. While anti-retroviral drugs have improved the outcome of AIDS patients, clinical research on the appropriate time to initiate therapy continues to evolve. Optimal therapy initiation would maximize the benefits of these drugs, while minimizing side effects and drug resistance. Recent 2013 WHO guidelines changed HIV therapy initiation from 350 cells/ μ L to 500 cells/ μ L. This systematic review provides an evidence-based comparison of starting treatment at >500 cells/ μ L with starting treatment at the range between 350 cells/ μ L and 500 cells/ μ L. An 11% increase in risk was detected from initiation therapy at the 350-500 cells/ μ L range (0.37 [0.26, 0.53]), when compared with starting treatment before 500 cells/ μ L (0.33 [0.22, 0.48]). Most individual study comparisons showed a benefit for starting treatment at 500 cells/ μ L in comparison with starting at the 350-500 cells/ μ L range with risks ranging from 19% to 300%, though a number of comparisons were not statistically significant. Overall, the study provides evidence based support for initiating anti retroviral therapy at cell counts >500 cells/ μ L wherever possible to prevent AIDS mortality and morbidity.
与首次发现该感染时相比，HIV感染如今已不再具有高发病率、迅速进展为艾滋病及死亡的特征。虽然抗逆转录病毒药物改善了艾滋病患者的治疗结局，但关于开始治疗的合适时机的临床研究仍在不断发展。最佳的治疗起始时机应能使这些药物的益处最大化，同时将副作用和耐药性降至最低。2013年世界卫生组织的最新指南将HIV治疗起始的细胞计数从350个/微升改为500个/微升。本系统评价对在细胞计数>500个/微升时开始治疗与在350个/微升至500个/微升范围内开始治疗进行了基于证据的比较。与在细胞计数<500个/微升时开始治疗（风险比为0.33[0.22,0.48]）相比，在350 - 500个/微升范围内开始治疗时检测到风险增加了11%（风险比为0.37[0.26,0.53]）。大多数个体研究比较显示，与在350 - 500个/微升范围内开始治疗相比，在500个/微升时开始治疗有益，风险范围为19%至300%，不过一些比较无统计学意义。总体而言，该研究为尽可能在细胞计数>500个/微升时开始抗逆转录病毒治疗以预防艾滋病的死亡率和发病率提供了基于证据的支持。
